Ibogaine in opioid detoxification

Evidence for effectiveness
Reporting from people who have taken ibogaine: Medical Ethnography
•Consistency among reports of treatment experiences and outcomes •The strongest attribution of efficacy is for the indication of acute opioid detoxification. •Variable interval of reduced drug craving following treatment, often on the order of weeks to months •The reports of individuals who have taken ibogaine may have mechanistic significance; e.g. descriptions of panoramic memory and “oneiric” state.
Major statistical findings regarding the ibogaine subculture
• The number of people who took ibogaine increased four-fold between 2001 and 2006 to an estimated total of 4,300- 4,900. • 68% took ibogaine for substance-related disorders. • 53% took ibogaine specifically for the treatment of opioid withdrawal; i.e., detoxification from typically high levels of physical dependence on opioids such as heroin and oxycontin
• Morphine • Cocaine • Amphetamine • Nicotine • Alcohol
How does it work?
Placebo?
Placebo responder ?
The published literature indicates no clinically significant placebo effect in opioid detoxification.
1. Alper, KR, Lotsof, HS, Frenken, GMN, Luciano, DJ, and Bastiaans, J (1999). Treatment of Acute Opioid Withdrawal with Ibogaine. American Journal on Addictions 8: 234-242. 2. Mash DC, Kovera CA, Pablo J, Tyndale R, Ervin FR, Kamlet JD, et al. Ibogaine in the treatment of heroin withdrawal. Alkaloids Chem Biol. 2001;56:155-71. 3. Luciano, DJ. (1998). Observations on treatment with Ibogaine. American Journal on Addiuse of ibogaine to reduce opioid analgesic tolerance, Ciba Pharmaceutical Corp., 1957
In animals, reduced drug self-administration in following ibogaine treatment has been reported for
June 1962, a heroin dependent lay drug experimenter serendipitously experiences the resolution of withdrawal following the use of ibogaine.
The nexus of harm reduction and ibogaine
Ibogaine in opioid detoxification
Kenneth Alper, M.D. Associate professor of Psychiatry and Neurology, New York University Presentation on ibogaine at Drug Policy Alliance Conference in Albuquerque, New Mexico, November 14, 2009 . Dr. Alper's presentation was one of a panel of six presentations organized and moderated by Howard Lotsof entitled "Ibogaine in Opiate Detoxification: How do we know it works? How does it work?"
Published Ibogaine Case Studies
• One paper describing 33 treatments for opioid dependence; complete resolution of withdrawal signs in 29 (88%)1. • Open label prospective study in St. Kitts N=32. Rating scales indicating resolution of withdrawal signs and symptoms at 24 hours, sustained improvement in depression scale scores at 1 month2. • 3 treatments, one for opioid dependence (Luciano et al. 1998)
• In these few studies that did include placebo, the placebo group had significantly greater signs of withdrawal and dropped out of the study more often versus any active treatment.
Triptych “Rise and Fall of Addiction” by Geerte Frenken
Left panel from triptych “Rise and Fall of Addiction” by Geerte Frenken
Ibogaine in the animal model
Clinical use of ibogaine
•Given most often for opiate detoxification, and also for dependence on other drugs such as methamphetamine and cocaine. •Typically administered as a single oral dose in the range of 10 to 25 mg/kg of body weight. •Advantages attributed by those who have been treated with ibogaine are higher tolerability relative to other standard treatments for acute opioid withdrawal, and post-treatment interval of diminished drug craving that may last days to month. •Low dose protocols involving repeated administration of 10 to 50 mg/day are becoming increasingly common particularly for the treatment of stimulant dependence.
“All models are wrong, some models are useful”- George E. P. Box
Iboga Alkaloid efficacy in the animal model: morphine withdrawal
• 11published independent replications in the rat, mouse and primate
Post-treatment outcomes
Table from Alper, K.R., Lotsof, H.S., 2007. The use of ibogaine in the treatment of addictions. In: Winkelman, M., Roberts, T. (Eds.), Psychedelic Medicine. Praeger/Greenwood Publishing Group, Westport, CT, pp. 43-66.
Opioid dependence is the central clinical focus of the ibogaine subculture
Graphic by an Amsterdam squatter for the International Coalition for Addict Self-Help, a group of Dutch Heroin users involved in ibogaine treatments.